Miscellaneous Topics

Transnasal Endoscopy

Thin transnasal endoscopes (diameter 5 - 6 mm) have been on the market for some time, and have been shown to be better tolerated than endoscopy via the oral route (without sedation) - possibly at the loss of image quality, although this is difficult to quantify. In a multicenter study in France involving 500 patients, the transnasal endoscope was compared with the standard gastroscope introduced transorally, and only a local spray was allowed. The rate of failure to intubate was higher with the transnasal route (6.8 % vs. 1.7 %), and visibility was better with the standard endoscope (significant only for the cardia). The transnasal route was better tolerated by patients (willingness to repeat endoscopy 90 % versus 75 %), although 25 % of patients reported pain in the nostrils [1]. A similar endoscope was used in routine practice in 1327 consecutive outpatients, with a mean examination time of 3.1 min (we had thought that Olympic records in gastroscopy were over) and a completion rate of 95 %, with good patient tolerance [2]. Two groups presented the next step - use of a battery-powered ultrathin endoscope (3 mm in diameter), which is intended only for esophageal examination; its accuracy in detecting disease was substantially inferior to that of standard EGD (sensitivities for various disorders 54 - 84 %) [3]. Another study found that patient acceptance of unsedated esophagoscopy, even with this very thin endoscope, was limited - only 50 % of the 48 patients who underwent both ultrathin and conventional endoscopy stated that they would prefer the thin scope in the future [4]. It remains to be seen whether slim endoscopes will be able to establish themselves, by improving both patient acceptance and image quality.

References

• 1 Ponchon T, Laurent J, Houcke P, et al. Nasal versus oral route for upper gastrointestinal endoscopy: result of a multicenter randomized study [abstract].  Gastrointest Endosc. 2001;  53 AB 116
• 2 Boschetto S, Festa V, Giovannone M, et al. Unsedated transnasal video gastroscopy in the routine practice: one year experience on 1327 patients [abstract].  Gastrointest Endosc. 2001;  53 AB 128
• 3 Catanzaro A T, Faux A L, Lee T J, et al. Accuracy of a narrow diameter battery powered endoscope in sedated and unsedated patients [abstract].  Gastrointest Endosc. 2001;  53 AB 82
• 4 Faulx A L, Catanzaro A T, Zysanski S, et al. Tolerance and acceptability of unsedated ultrathin esophagoscopy (UUE) [abstract].  Gastrointest Endosc. 2001;  53 AB 83
• 5 Desai D S, Barkin J S, Amaro R, et al. Evaluation of the Olympus SIF-Q140 enteroscope for the investigation of suspected small bowel pathology [abstract].  Gastrointest Endosc. 2001;  53 AB 210
• 6 Cuillerier E, Ghandour M, Lepere C, et al. Comparison of upper and double way push enteroscopy in patients with acute unexplained hematochezia [abstract].  Gastrointest Endosc. 2001;  53 AB 207
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• 16 Prasad B, Mukhood M, Wong M, et al. Oesophagogastroduodenoscopy (OGD) performed by experienced nurse endoscopists for dyspeptic symptoms: are results similar to those obtained by medical staff?.  Gastrointest Endosc. 2001;  53 AB 79
• 17 Prasad B, Smale S, Gruber A, et al. Nurses can perform oesophagogastroduodenoscopy with as little patient discomfort and as much patient satisfaction as physicians [abstract].  Gastrointest Endosc. 2001;  53 AB 80
• 18 Rajan E, Buess G, Dean R, et al. First endoscopic system for transmural resection of colorectal tissue using a prototype full-thickness resection device (FTRD) [abstract].  Gastrointest Endosc. 2001;  53 AB 58
• 19 Raijman I, Baluvut A R, Lehman G A. Management of tracheoesophageal fistulas (TEF) via endoscopic suturing: report of 3 cases [abstract].  Gastrointest Endosc. 2001;  53 AB 146
• 20 Ben-Menachem T, Goel S. Non-GERD applications for the endoscopic suturing device [abstract].  Gastrointest Endosc. 2001;  53 AB 130
• 21 Ezzeddine D Z, Jit R, Katz N, et al. Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis [abstract].  Gastrointest Endosc. 2001;  53 AB 63
• 22 Feretis C, Benakis P, Dailianas A, et al. Endoscopic implantation of micro-balloons in the management of fecal incontinence [abstract].  Gastrointest Endosc. 2001;  53 AB 57